February 3, 2014

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Free First Friday Educational Program Offered Friday on Payment Reform

MMA presents Preparing for Payment Reform, a three hour CME program, on this coming Friday, February 7th from 9:00 am to noon.  There is no cost to attend or participate via webex.  

Members or practice staff interested in attending may register online (do not enter payment information) or by calling 622-3374 (press 0).  

Faculty for the session includes attorney Ben Townsend who prepared a legal toolkit for physician practices looking to understand and prepare for new payment models.  In addition to the legal toolkit, attendees will hear from experts in the fields of financial analysis, professional liability insurance and patient engagement. The agenda for the program is as follows:

9:00am  Welcome and introductory remarks.   Gordon Smith, Esq.
9:15am   Legal Considerations for Physician Practices.  Ben Townsend, Esq.
9:45am   Evaluating Approaches to Cost Accounting and Data Analytics.  Steven McGrath, MBA
10:15am  BREAK
10:30am  Malpractice Coverage.   Chip Harris, Kilbride & Harris Insurance Services
11:00am  Research, Strategy and Communication Approaches to Adapting to Payment Reform    Beth Austin, Crescendo Consulting Group
11:30am   Panel and Attendee Discussion

There is no charge for this special First Friday presentation because of financial support from the Maine Health Access Foundation (Payment Reform grant).

AMA, MMA and Others Continue to Seek Repeal of Current Medicare Payment Formula

MMA staff participated in a conference call with AMA governmental affairs staff last week and heard updates on the current efforts to repeal the sustainable growth rate (SGR) formula which has resulted in nearly annual scheduled reductions in physician reimbursement under Medicare.  If the formula is not repealed or other legislation passed by March 31 further extending the relief granted in December, physicians would see an approximately 20% decrease in reimbursement.  The three committees of jurisdiction continue to work on various aspects of an alternative which would replace the existing formula with new approaches that rely, in part, on performance metrics developed by physicians.

There is not yet agreement on how to pay for the SGR fix but the so-called "pay-fors" are likely to come not from new taxes but from cuts to other providers or the Overseas Contingency Account (OCA).

All four members of Maine's congressional delegation are committed to supporting a permanent fix to the flawed formula but none are on any of the committees working actively on the legislation.

Because of this year's election and the Presidential election in 2016, there is a belief among many observers that if we don't repeal the formula now, when the cost to do so is lower than expected because of new projections by the Congressional Budget Office, there may not be another window of opportunity to do so until 2017. [return to top]

MMA Legislative Committee Weekly Conference Call, Tuesday, 2/4/14, 8 p.m.

Tthe next MMA Legislative Committee weekly conference call will take place tomorrow, Tuesday, February 4th at 8:00 p.m. 

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-619-326-2772 

Passcode:  729-7185

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.  The MMA staff lists a suggested position for each bill and any medical specialty particularly affected by the bill.

If you have an opinion about any of these bills, but cannot participate in the call, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

The MMA staff has been hard at work scheduling Doctor of the Day volunteers for the second session of the 126th Legislature.  This month, we still have an opening for February 13th.

If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA at docoftheday@mainemed.com. You can submit your registration on line. We hope to see you at the State House for what is expected to be a very interesting session for the medical community.

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first.

LD 1759Resolve, Implementing the Recommendations of the Commission To Study the Incidence of and Mortality Related to Cancer (monitor; Public Health Committee)

[return to top]

POLITICAL PULSE: Weekly Activities at the State House

Health and Human Services Committee Hears Reports on ASC Reimbursement, Krabbe Disease 

The Health and Human Services Committee heard updates this week on MaineCare reimbursement for ambulatory surgical centers (L..D. 390) and efforts to educate clinicians about Krabbe disease (L.D. 181).  Maine Chapter, AAP President Steve Feder, D.O. sent a written report to the Committee describing the Chapter's genetics educational session at its fall meeting and its plans for some education more specifically on Krabbe at its Spring 2014 meeting.  Representatives of DHHS reported that they were unable to conduct any meaningful analysis of the potential savings to the MaineCare program by re-establishing coverage for services provided in ASCs and Committee members seemed very frustrated by this.  The Committee's Senate Chair, Margaret Craven (D-Lewiston), allowed MMA Deputy EVP to reiterate the MMA's argument in favor of covering ASC services.  L.D. 390 remains on the Appropriations Table and the MMA will continue to urge passage of the bill despite the modest fiscal note.

The Committee also held hearings and work sessions on a number of bills MMA was monitoring, including LD 1599 regarding the safe handling of hazardous drugs (voted ought not to pass at the recommendation of the sponsor) and LD 1592 regarding the jurisdiction of local health inspectors. 

Insurance Committee Focuses on "Narrow Networks" 

The Insurance and Financial Services Committee took up two bills this week related to health insurance company provider networks.  Both bills stemmed from concerns over certain hospitals and providers being omitted from the Anthem plans being offered on the new health insurance marketplace and initially proposed for all Anthem individual and small-group plans.  LD 1629 would require that if an insurance company creates a so-called "narrow network" of providers, providers would have a right to know the basis for creating the network and have certain appeal rights if not included.  LD 1676 was amended by the sponsor before the hearing to state that insurance companies would have to contract with "any willing provider" who meets the criteria established by the carrier.  The Committee held a public hearing on both bills last Tuesday and a work session last Thursday.  The Committee tabled both bills for further discussion this week.  MMA is monitoring the proposals.  

Education Committee Holds Hearing on HIV Education 

The Education Committee held a hearing last week on LD 1699, a bill that would replace lost funding in the Department of Education that provided training in evidence-based HIV prevention curricula for educators throughout the state and supported youth-lead initiatives around HIV. MMA submitted written testimony in favor of the measure. 


[return to top]

Primary Care Practice Reports Being Sent to all Primary Care Practices in Maine

On Jan. 30, the Maine Health Management Coalition Foundation began distributing Primary Care Practice Reports to all Primary Care practices in Maine. This work is supported by the State of Maine’s State Innovation Model (SIM) award.

The goal of the Primary Care Practice Report is to demonstrate practice pattern variation in cost and quality compared to state benchmarks.

The Primary Care Practice Report displays information based on medical and pharmacy claims data for all patients attributed to a given primary care practice. The report is based on ALL of the attributed patient’s claims data, regardless of where care was received. Example: Jane Doe is attributed to Fictional Family Practice. Fictional Family Practice’s Primary Care Practice Report is based on all of healthcare services Jane received, regardless of the servicing provider or location of service. For instance, all of the specialty care Jane received for a knee replacement, outside of her primary care practice, will be included in the Fictional Family Practice’s report.

Please note that the Primary Care Practice Report is the property of the practice and will not be released directly to the public or distributed to others without written consent.

The Maine Health Management Coalition Foundation will be offering introductory regional trainings throughout March 2014 they will be presenting detailed descriptions of the report content, responding to questions, and providing support to help attendees understand and identify ways to use these reports to drive improvement. 

In the event you cannot make a regional training, a pre-recorded webinar and regional training are available here: http://www.mehmc.org/providers/primary-care-practice-reports/ 

Please feel free to follow up with the MHMC data team (data@mehmc.org) to discuss any questions you may have concerning your report. 

[return to top]

2014 Medicare Physician Fee Schedule Available

New England's Medicare contractor, National Government Services, has now posted the 2014 Medicare physician fees to its website.  The good news is that many claims have been received in 2014 and NGS has begun to process claims using the new schedules meeting all CMS timeliness requirements.      

www.ngsmedicare.com has a tool available to assist offices in searching for fee schedules using the appropriate state and locality by type of service provided.  All fees were added to the website earlier this month.  Search tools are  available individual code or the entire file.  Many find the individual code search easier to navigate.   

Knowing that the current legislation expires on March 31, 2014, NGS will be sharing updated information as it is received. This link will direct to you to the complete fee schedule file. [return to top]

Support Maine's Pre-litigation Screening Panels by Serving as a Volunteer Panel Member

The primary reason Maine's medical liability premiums are among the lowest ten states in the country is the existence of our very effective, and mandatory, pre-litigation screening panel system.  The legislation authorizing the panel system was effective in 1988 meaning that we have had a 25 year experience withe the system.  Even many trial lawyers now acknowledge its effectiveness.

Perhaps because the legislation was passed many years ago, many of our newer licensees are not aware of the panels and the important role they play in keeping premiums down and in moving the process along.  If you are asked to serve on a panel, please step up to the plate and do so.  Should you be a defendant someday, you would want a volunteer physician on your panel.

During the current legislative session, MMA is also supporting legislation that would increase the compensation paid to the panel chairs.  The chairs are part-time and persons with judicial experience.  They are paid approximately $50 per hour and there has not been an increase in the judicial budget for them since the law was enacted.  Quite frankly, the system would not work without the integrity and hard work of the three individuals who currently chair the vast majority of the panels. An increase in their compensation is way overdue. [return to top]

ICD-1O Informational Series, Part IV: Example of Coding Changes

As a result of feedback from MaineCare’s Provider Readiness survey participants, MaineCare has developed an ICD-10 Informational Series for providers in order to share information and to direct practices towards preparing for transitioning from ICD-9 to ICD-10.

Part IV: Example of Coding Changes

Provider Readiness Survey results indicated that providers would benefit from understanding how ICD-10 is different from ICD-9. As a result, MaineCare would like to share the information below, which describes some of the changes in ICD-10. For more detailed information, please see the resources listed at the bottom of this message.

How are ICD-10 codes different from ICD-9 codes?

Longer codes: ICD-9 codes are 3-5 characters, while ICD-10 codes can be up to 7 characters. 

  • Providers need to make sure their systems, processes, and forms can accept the new, longer codes.

More granular: ICD-10 codes are far more granular than ICD-9 codes and provide much more specific information.

  • The greater specificity of ICD-10 means that one ICD-9 code can be represented by multiple ICD-10 codes.
  • Providers need to determine which ICD-10 codes to use in place of ICD-9 codes.

The following example shows how one ICD-9 code can be represented by multiple ICD-10 codes:

ICD-9 Code

  • 996.71, Other complications due to heart valve prosthesis

ICD-10 Codes

  • T82.817A, Embolism of cardiac prosthetic devices, implants and grafts, initial encounter
  • T82.827A, Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter
  • T82.837A, Hemorrhage of cardiac prosthetic devices, implants and grafts, initial encounter
  • T82.847A, Pain from cardiac prosthetic devices, implants and grafts, initial encounter

Centers for Medicaid and Medicare Services (CMS) has provided a tool, called General Equivalence Mappings (GEMs) that can assist providers with determining which ICD-10 codes to use. You can access GEMS on the CMS website.

For more information, go to MaineCare’s ICD-10 webpage or CMS’s ICD-10 Provider Resources’ webpage. Please send questions about ICD-10 to MaineCare’s ICD-10 email box.

[return to top]

SIM Steering Committee Updates

The State Innovation Model Grant (SIM) steering committee met on January 22, 2014.  Health care professionals are represented on the committee by Rhonda Selvin, APRN and Noah Nesin, MD, FAAFP.  Both continue to welcome feedback from MMA members and other clinicians.  The SIM grant is a $33 million three-year grant that will test whether new payment and service models will produce superior results and lower costs.

Minutes and supporting documents regarding the grant are are posted on the SIM webpage, recently revamped: http://www.maine.gov/dhhs/sim/

At the meeting on the 22nd, the steering committee received the following updates, along with addressing additional issues:

  • Frank Johnson: The payment reform subcommittee is meeting in an effort to align quality and payment metrics. Of the greater than 250 measures identified so far by the subcommittee, only 54 overlap by 2 or more sources. 
  • Katie Sendze: The data reform subcommittee is in the process of being updated by the other two subcommittees and working in the areas of behavioral health homes and a patient portal RFI (released last week).
  • Lisa Tuttle: The system reform subcommittee is focusing on updating the primary care learning collaborative around the Behavioral Health Home. 
  • Dr. Jay Yoe: The evaluation subcommittee will use Re-AIM framework as a guideline for areas of focus. 
  • An evaluation team site visit is planned for the last week of February, conducted by RTI who will attend leadership team and steering group meetings and conduct stakeholder interviews.

[return to top]

Connecting to HealthInfoNet Webinar Available

Did you miss the January 21 MMA Payment Reform Webinar on “Connecting to HealthInfoNet (HIN) for Better Coordination and Outcomes” featuring Shaun Alfreds from HIN followed by a hands-on demonstration of how David Hallbert, MD and Molly Stevens, RN use HIN to enhance their primary care practice at Martin’s Point Health Care in Bangor? A recording of this webinar is available here.

[return to top]

HealthInfoNet Patient Portal HIE Access Request for Information (RFI)

Do you want to be the FIRST in Maine (and perhaps the nation) to provide patient's access to their statewide HIE record? Does your organization value and seek to improve patient engagement? Then keep reading!

About the Project

As part of the State Innovation Model test grant, HealthInfoNet is seeking one pilot partner to link their organizations patient portal or personal health record (PHR) to the health information exchange (HIE). Once linked HealthInfoNet will use "blue button" technology standards to allow patients to download a continuity of care document (CCD) that gives them a summary of their statewide HIE record. To learn more about the SIM project, visit the State's SIM website

Why Participate?

As a pilot site, your organization will be the first in the State of Maine to provide patients access to their statewide HIE record. This pilot will be a great opportunity to build upon your current patient engagement campaigns and make you a national leader in the movement to provide patients access to their medical information. To help develop communications strategies for your patients and community, your organization will receive assistance from the HealthInfoNet Consumer Advisory Committee, which includes consumer advocates and representatives from consumer advocacy and education organizations. This will be an especially valuable tool to help your patients and their caregivers in managing their chronic disease and complex care plans across multiple providers. 

About the Pilot Selection Process

There are operational and technical requirements in order to participate, please fill out the survey linked here  in order to be considered for the project. HealthInfoNet expects to identify the pilot partner by April 1st. The survey will be open until February 14th. For more information or questions please email Katelyn Michaud at kmichaud@hinfonet.org

[return to top]

Upcoming Events

The Maine Chapter of the American Academy of Pediatrics (MAAP)“Visiting Professor” Program

Dr. Kenneth Ginsburg on Building Resilience

Wednesday, February 19th (Waterville/Augusta) and 
Thursday, February 20th (Bangor)

To learn more about Dr. Ginsburg and register for the opportunities in February in Maine, please click here.

Registrations will close by Friday, February 7th and registrants will be notified by Monday, February 10th.  


The Maine Public Health Association (MPHA) Tobacco Webinar Series  

The Answers Are Out There: Best Practice Strategies to Reduce Tobacco Use

February 27th, 2014 at 2:00 pm 

Register Now 

Speakers: American Cancer Society Cancer Action Network and American Heart Association

Consider the Source: The Intersection Between the
Fund for a Healthy Maine and Tobacco Prevention and Control

March 20, 2014, 2:00 pm 

Register Now 

Speakers: Friends of the Fund for a Healthy Maine and MPHA

Sex Sells: the Wild, Wild East—Emerging Tobacco Trends

May 15, 2014, 2:00 pm 

Register Now  


CODEquest 2014 - Conquering ICD-10

Sponsored by the American Academy of Ophthalmic Executives, a division of the American Academy of Ophthalmology, and the Maine Society of Eye Physicians and Surgeons.

Friday, March 7, 2014

11:00am - 4:15pm

Harraseeket Inn, Freeport, ME

Details and Registration are available at:  http://www.aao.org/aaoe/coding/codequest-maine.cfm or contact Peggy Coakley at pcoakley@aao.org or 415-561-8561.


Save the Date!   

Quality Counts 2014 Annual Conference 

Wednesday, April 2, 2014

Registration materials and information will be available in February at www.mainequalitycounts.org or by calling QC at 207.620.8526, ext. 1004. 


Maine Society of Eye Physicians and Surgeons Spring Educational Program and Business Meeting

Friday, May 2, 2014

12:00pm - 4:45pm

Harraseeket Inn, Freeport, ME

For more information, please contact Shirley Goggin at sgoggin@mainemed.com or 207-445-2260.


[return to top]

Job Openings

ED Provider Jobs

Challenging, Lucrative, ED Provider jobs in central Maine - honoring and serving Veterans.  ED Physicians are needed in Augusta. Must-have an unrestricted medical license (from any U.S. state), and current ACLS certification. This is your opportunity to use and develop your skills of diagnosing, treating, and managing patients according to standard, usual, and acceptable methods and techniques.

B/C or B/E specializing in EM, IM, or FP by the appropriate accrediting agencies (EM preferred).

This is the opportunity for you to receive a competitive salary, a generous leave package, excellent health & life insurance benefits, and retirement benefits. You'd be eligible to participate in a pension program as well as a matching Thrift Savings Plan which is similar to a 401K. If you are a veteran, you may be able to combine accrued military retirement credit with VA pension benefits.

Your salary will be determined by local Physician/Dentist Compensation Panel (commensurate with education, experience and qualifications). By law, U.S. Citizens will be given 1st preference but non-citizens will be considered in the absence of qualified citizens. A signing bonus may be available.  Equal Opportunity Employer. Disabled persons and/or veterans are encouraged to apply.

FMI, call John Poulin at (877) 421-8263 x6913, or email him at john.poulin@va.gov

To apply, go to https://www.usajobs.gov/GetJob/ViewDetails/328066200


Psychiatrist, Psychiatric Nurse Practitioner and/or Physician’s Assistant 

Assistance Plus is seeking a full time psychiatrist, psychiatric nurse practitioner and/or physician assistant for the Medication Management Program in Wilton.  The professional team is overseen by Robert Gordon, medical director.  Our primary focus is to assist those with behavioral health disorders. 

Applicant must be a graduate of an accredited degree program and licensed to practice in the State-of-Maine.  A minimum of three years experience required. 

We offer a generous benefit package of full coverage for health, dental, and 401K.  This position is Monday through Friday and no on call coverage is required.

Please submit resume and cover letter to Kelly Negm 453-4708 ext 303 or email knegm@assistanceplus.com


Department of Psychiatry Faculty Position

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, in a productive collaboration with the State of Maine, is seeking a psychiatrist to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

Riverview Psychiatric Center is a 92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient treatment center for Maine’s public mental health system.  Psychiatrists with expertise in general inpatient psychiatry or forensic psychiatry are encouraged to apply.

Academic duties can include teaching and supervision of medical students and residents. Research opportunities available and encouraged.

Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to psychiatry.jobs@dartmouth.edu.  Please reference search number PS1013D.

The Geisel School of Medicine at Dartmouth is an Equal Opportunity/Affirmative Action Employer and encourages applications from women and members of minority groups.


Seeking Contract Academic Detailer / Prescriber Educator

The Maine Medical Association, on behalf of the Maine Independent Clinical Information Service (MICIS), is seeking a clinical health professional to serve in the role of a contract “academic detailer.”  Academic detailing entails offering independent, scientific evidence on prescription drugs at the request of prescribers working in primary care.

The part-time contract academic detailer will conduct face-to-face educational outreach visits to discuss the current evidence on best clinical prescribing practices.  The candidate will be available to do one-on-one consultations with prescribers and group teaching sessions in practices, hospitals and at conferences, per request, across the state.

Hours required will vary from month to month, based on demand, and may range anywhere from 5 to 35 hours a month. Flexibility is required. One-year contract subject to renewal.


Candidates must be available to attend a two-day training session in Boston on the principles and techniques of academic detailing.  Additional trainings on specific clinical topics to be detailed will take place in Maine or Boston periodically.


  • Clinical background: MD, PA-C, RN, CNP, or PharmD or similar.
  • Two or more years of clinical experience.
  • Therapeutic competency.
  • Strong interpersonal skills including service-orientation.
  • Excellent presentation and public speaking skills.
  • Ability for light lifting when delivering presentation materials to sites.
  • Ability to travel throughout the state including occasional long days driving and overnight stays in Maine and Boston.
  • Ability to attend monthly work group meeting (mornings) and quarterly advisory committee meetings (afternoons) in Manchester.

Pay:  The contractor will be paid on an hourly basis commensurate with the candidate’s background and skills.

Contact:  Please send cover letter and resume by Feb. 28 to Jennifer Reck, MA, MICIS Program Manager, at jreck@mainemed.com.


[return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association